chapter 42

  1. The nurse is assisting with a community education class on breast cancer prevention. Which of the following are risk factors the nurse should include?

    a.

    High-fat diet and alcohol intake

    b.

    Early first pregnancy and late menarche

    c.

    Large or pendulous breasts

    d.

    History of breastfeeding
    ANS:    A

    Factors that increase the risk of development of breast cancer include increasing age, personal or family history of breast cancer, high-fat diet, high alcohol intake, treatment with estrogens (especially when used without progestins), early menarche, late menopause, no pregnancy or late first pregnancy, and no breastfeeding or breastfeeding for short periods of time following delivery.
  2. The nurse is caring for a patient who had a mastectomy for breast cancer 2 days ago and is now developing pulmonary congestion. Why is a mastectomy patient at risk for pulmonary complications?

    a.

    Mastectomy patients must remain on bedrest for 48 to 72 hours postoperatively.

    b.

    Pathogens may have been introduced during the surgical procedure.

    c.

    The chest incision makes the patient hesitant to deep breathe and cough.

    d.

    Breast cancer has often spread to the lungs before diagnosis.
    ANS:     C

    Patients can have ineffective breathing patterns and difficulty coughing because of pain with chest movement. Bedrest is not necessary. Pathogens should not be introduced during surgery, and the mastectomy site is not the same as the lungs. Breast cancer does not often spread to the lungs before diagnosis.
  3. The nurse is caring for a patient who had a left mastectomy earlier in the day and informs the nurse of the following concerns. Which should the nurse attend to first?

    a.

    Her bowels have not moved in 48 hours.

    b.

    She has a pain level of 7 on a 0 to 10 scale.

    c.

    She has a 3-cm area of blood on her wound dressing.

    d.

    She feels anxious about how her husband will react to her surgery.
    ANS:     B

    Pain, constipation, and bleeding are all physiological needs, which take priority over psychosocial needs (anxiety) on Maslow’s hierarchy. Because 3 cm of blood is not urgent, and a few more minutes of constipation will not make a difference in the outcome, the pain should be treated first.
  4. The nurse is assessing a patient after a mastectomy and thinks the patient’s affected arm appears swollen. What is the best way to verify this finding?

    a.

    Measure and document the circumference of the arm.

    b.

    Ask the patient to hang the arm down for 3 minutes and check for increased swelling.

    c.

    Press a finger into the arm and measure the indentation.

    d.

    Measure and compare the circumferences of both arms.
    ANS:    D

    The best measure is comparing the affected side with the patient’s opposite side. Measuring, checking for pitting edema, and documenting are not as significant if not compared with the normal side. Hanging the arm down will not help and may worsen the swelling.
  5. The nurse enters the room of a patient with a new mastectomy and finds her crying. After confirming that the patient is crying because of the loss of her breast, which response by the nurse is best?

    a.

    “I know how you feel. It is difficult to lose a breast.”

    b.

    “At least they got all the cancer. You are fortunate.”

    c.

    “How have you coped with other problems in your life? Do you have someone you can talk to?”

    d.

    “Here, have a tissue. I know you feel like crying now, but before you know it you will feel much better, and this will all be behind you.”
    ANS:     C

    Further assessment, as in C, can guide the nurse’s next actions. A, B, and D all belittle the patient’s concerns. The nurse does not know how the patient feels.
  6. A patient reports long, heavy, irregular menses accompanied by headache and back pain for the past several months. Which of the following is the best term to use to document these symptoms?

    a.

    Menometrorrhagia

    b.

    Polymenorrhea

    c.

    Oligomenorrhea

    d.

    Hypermenorrhea
    ANS:    A

    Menometrorrhagia is long, heavy, irregular menses. Polymenorrhea is frequent menses; oligomenorrhea refers to cycles longer than 35 days; and hypermenorrhea is menses lasting longer than 7 days.
  7. The nurse is teaching a woman with a menstrual disorder how to measure menstrual flow. Which instruction should the nurse include?

    a.

    Use a vaginal catheter and collection bag.

    b.

    Use a perineal collection system.

    c.

    Weigh the woman before and after her menses.

    d.

    Weigh her perineal pads before and after use.
    ANS:    D

    Estimation of the amount of blood lost during menses may be difficult because pad counts can vary widely, depending on the frequency of pad changes and the portion of the pad that contains blood. The only accurate way to estimate menstrual flow is by weighing the pads (sealed in a biohazard bag) and then subtracting the weight of the original pads. Weighing the woman is inaccurate because there are too many other factors affecting weight. Catheters and collection systems may be used for urinary drainage but not for vaginal collection.
  8. A woman tells the nurse, “I am having terrible pain with my period. This has never happened before. What should I do?” What is the best response by the nurse?

    a.

    “Dysmenorrhea is a common occurrence; NSAIDs or aspirin may help.”

    b.

    “The best way to combat painful menses is to exercise and drink plenty of fluids.”

    c.

    “Sometimes getting into a knee–chest position is helpful.”

    d.

    “You should notify your doctor if this is a new experience for you.”
    ANS:    D

    The nurse should never give advice until a diagnosis is known. At that time, it may be appropriate to teach measures to increase comfort during periods, such as NSAIDs, exercise, or positioning.
  9. A patient comes to an outpatient clinic because of premenstrual syndrome (PMS) symptoms. What advice from the nurse may help her reduce her symptoms?

    a.

    “Avoid strenuous exercise for several days before and after your period.”

    b.

    “Avoidance of alcohol and caffeine may help reduce your discomfort.”

    c.

    “Ask the physician about a mild antianxiety agent.”

    d.

    “There is no treatment for PMS other than rest and fluids.”
    ANS:     B

    The nurse can provide educational materials on lifestyle measures, such as restriction of alcohol, caffeine, nicotine, salt, and simple sugars; participation in regular exercise; and development of stress management skills. Antianxiety agents are generally not used and would not be considered until nonpharmacological interventions are tried.
  10. A 50-year-old woman states, “It is such a relief not to need birth control any more. I haven’t had a period in 3 months.” How should the nurse respond?

    a.

    “You may still be fertile for several months after your last period. You should consult with your physician to know when to stop using birth control.”

    b.

    “You should continue to use birth control for at least 6 months after cessation of your periods.”

    c.

    “Birth control is usually unnecessary after age 50, even if you are still having periods.”

    d.

    “It is still possible for you to get pregnant. You should consider having a tubal ligation.”
    ANS:    A

    It is important to remind perimenopausal women that they may still be fertile after several months of amenorrhea. To prevent conception, they need to continue to practice birth control until they receive confirmation from their primary care provider that menopause is complete. Six months is not a magic number. A tubal ligation is not necessary, because only a brief time of needing protection remains.
  11. The nurse recognizes that which of the following women is most likely predisposed to developing a vaginal yeast infection?

    a.

    A 23-year-old who eats a high-protein diet

    b.

    A 38-year-old woman who frequently uses NSAIDs

    c.

    A 31-year-old woman who runs 2 miles every day

    d.

    A 28-year-old woman who sits at a desk 5 days a week
    ANS:    D

    Several conditions can predispose patients to an overgrowth of resident microbes: poor nutrition (especially diets high in simple sugars), inconsistent control of blood glucose levels in patients with diabetes, stress, pregnancy, marked hormonal fluctuations, pH changes, prolonged overheating of the genital area with little aeration (as happens with sitting still for long periods in overly restrictive clothing), and changes in the balance of vaginal flora types because of antibiotic (not NSAID) treatment or douching.
  12. The nurse is assisting with teaching a patient who has been placed on metronidazole (Flagyl) for bacterial vaginosis. What instruction by the nurse is appropriate?

    a.

    “Take the Flagyl until the discharge is gone for at least 24 hours.”

    b.

    “Take the Flagyl as prescribed, even if your symptoms are gone.”

    c.

    “Take the Flagyl whenever you feel vaginal itching or irritation.”

    d.

    “You will need to take Flagyl for an extended period. This prescription has several refills.”
    ANS:     B

    Teach the patient to avoid alcohol use while on the medication and for 48 hours after completion. Use medication as directed, even if symptoms cease. Take with meals. Treat partner. Antibiotics are not prescribed prn and are not usually needed for extended periods.
  13. A patient is seen in a clinic for contact vaginitis. What information from her history helps the nurse to plan teaching for the patient?

    a.

    She has had a urinary tract infection (UTI).

    b.

    She has been on oral antibiotics for a sinus infection.

    c.

    She has been under stress at work.

    d.

    She takes bubble baths every night.
    ANS:    D

    Contact vulvo-vaginitis can be related to contact with allergens or irritating chemicals such as contraceptive creams or bubble baths. Vaginitis is inflammation, not infection. UTI does not predispose to vaginitis. Stress and antibiotics are more likely to place the patient at risk of infection, not inflammation.
  14. The nurse is teaching a patient how to use a daily vaginal suppository. Which of the following statements indicates that teaching has been effective?

    a.

    “I should put the suppository in at night after I get into bed.”

    b.

    “It is best to insert the suppository each morning after a shower or bath.”

    c.

    “The suppository should be put in late in the day when I’m less likely to be active.”

    d.

    “I should put the suppository in each morning before I get out of bed.”
    ANS:    A

    Application of vaginal medication is easiest when the patient is lying down ready to sleep, because vaginal medications tend to run out when the patient stands or sits. Using it at other times risks losing much of the medication and its effect.
  15. A 16-year-old girl is admitted to the hospital with toxic shock syndrome (TSS). Which action by the nurse should take priority?

    a.

    Teach the girl risk factors for TSS.

    b.

    Teach the girl’s mother risk factors for TSS.

    c.

    Determine what the girl understands about risk factors for TSS.

    d.

    Educate the girl on signs and symptoms of TSS.
    ANS:     C

    At 16, the girl is at an age at which she needs to understand the risk factors, not her mother. Assessment of baseline knowledge should always take place before teaching risk factors or signs and symptoms.
  16. Which term is used to describe the sagging of the bladder into the vagina?

    a.

    Rectocele

    b.

    Cystocele

    c.

    Dyspareunia

    d.

    Bladder fistula
    ANS:     B

    Cystocele occurs when the bladder sags into the vaginal space because of inadequate support. Rectocele occurs when a portion of the rectum sags into the vagina because of inadequate support. Dyspareunia refers to pain with intercourse. Bladder fistula is a tract from the bladder to another location.
  17. The nurse is assisting with teaching a woman who is having difficulty conceiving. What instruction should the nurse provide about keeping a basal body temperature chart?

    a.

    “Starting with the first day of your period, record your temperature first thing each morning.”

    b.

    “Record your temperature every 4 hours, starting the first day of each month.”

    c.

    “Record your temperature in the late afternoon each day for 3 months.”

    d.

    “Record your temperature three times each day of your period, then once a day thereafter.”
    ANS:    A

    The nurse teaches the patient to keep a precise record of her oral temperatures with a basal thermometer each morning on awakening, before any other activity. The first day of her menses is day 1 on the temperature chart. Changing levels of hormones result in slight temperature changes, which can be used to identify when ovulation seems to be occurring and when particular hormone levels should be tested.
  18. A female patient has just learned that she is infertile. She says, “All I ever wanted in life was to have a baby. My life is over.” What is the best response by the nurse?

    a.

    “You are overreacting because you are upset. Your life really is not over.”

    b.

    “You have a wonderful husband. Maybe you should think about adoption.”

    c.

    “A baby must have been very important to you. When you feel ready, we can talk about other alternatives.”

    d.

    “There is an infertility clinic I just heard about in Mexico. Do you want the address?”
    ANS:     C

    C reflects back to the patient and offers information about options when the patient is ready. A and B belittle the patient’s feelings and offer advice, which is inappropriate. D is dangerous and not the role of the nurse.
  19. A patient at a walk-in clinic requests oral contraceptives (OCs) because she heard they can prevent sexually transmitted diseases (STDs). On which understanding should the nurse base the response to the patient?

    a.

    Only OCs with estrogen and progestin can prevent STDs.

    b.

    Not enough research has been done to prove that OCs can prevent STDs.

    c.

    There is no connection between OC use and risk of STDs.

    d.

    OCs provide excellent protection against most STDs.
    ANS:     B

    There is much debate about whether hormonal contraceptive agents may offer some protection against some STDs, based on lower statistical rates of STDs among oral contraceptive users. However, cellular changes of the cervix seen with hormonal contraceptive use actually tend to be associated with higher rates of some STDs. Unless some specific mechanism of prevention is demonstrated by research, it seems irresponsible to suggest that OCs alone offer protection against anything other than pregnancy. Therefore, women should still be advised about the risks of contracting STDs while taking an OC.
  20. A patient must prevent pregnancy while she is receiving chemotherapy that could harm a fetus. What type of birth control does the nurse anticipate teaching the patient about?

    a.

    Condom

    b.

    Diaphragm with spermicide

    c.

    Depot medication

    d.

    Oral contraceptive
    ANS:    D

    Oral contraceptives are the most effective for preventing pregnancy during chemotherapy. Depot medications are next, and barrier methods are the least effective of those listed.
  21. The nurse is assisting a new mother who returns to a clinic for a 6-week visit. What instructions about birth control should the nurse provide?

    a.

    “As long as you are breastfeeding, you will not get pregnant.”

    b.

    “You should avoid having intercourse until you are finished breastfeeding.”

    c.

    “You should plan to use birth control; breastfeeding is not a reliable form of contraception.”

    d.

    “Breastfeeding has no effect on your ability to conceive.”
    ANS:     C

    Breastfeeding is sometimes used as a method of birth control because the high blood levels of prolactin that occur with breastfeeding may suppress ovulation. This method costs nothing but is not very effective. Avoiding intercourse while breastfeeding is unrealistic.
  22. A patient is scheduled for a hysterectomy and bilateral salpingo-oophorectomy. She asks what this means. How should the nurse respond?

    a.

    “You are going to have your uterus, fallopian tubes, and ovaries removed.”

    b.

    “You will have your uterus and fallopian tubes removed, but your ovaries will remain intact.”

    c.

    “You will have your uterus removed and your bladder suspended.”

    d.

    “You will have your uterus removed and your fallopian tubes and ovaries sutured in place.”
    ANS:    A

    Removal of the uterus, the tubes, and ovaries is called total abdominal hysterectomy with bilateral salpingo-oophorectomy, or panhysterectomy. Removal of the uterus alone is called hysterectomy. Bladder suspension is a separate procedure.
  23. The nurse is caring for a woman who had a hysterectomy this morning. Four hours later the woman is unable to urinate. What assessment would determine bladder distention and be comfortable for the patient?

    a.

    Palpate for bladder distention.

    b.

    Percuss the bladder for fullness.

    c.

    Perform a scratch test.

    d.

    Palpate for rebound tenderness.
    ANS:     C

    Assess bladder fullness using Doppler monitoring or scratch test (listening with a stethoscope, lightly scratch abdomen as you move downward from xiphoid until you hear change in sound indicating the top of the bladder). Palpation and percussion can be uncomfortable near an incision and over a full bladder.
  24. A 42-year-old woman is tearful after a hysterectomy. Which of the following understandings helps the nurse to respond appropriately to the patient?

    a.

    Most women are done bearing children by age 42.

    b.

    Most women are happy not to have periods after a hysterectomy.

    c.

    Loss of reproduction function may cause grieving.

    d.

    Hysterectomy is more traumatic for younger women.
    ANS:     C

    Patients may grieve at the loss of reproductive status, regardless of age. Not having periods does not necessarily negate the pain of loss.
  25. What treatment reduces symptoms of primary dysmenorrhea by blocking prostaglandin synthesis?

    a.

    Vitamins

    b.

    Antacids

    c.

    Morphine

    d.

    NSAIDs
    ANS:    D

    Primary dysmenorrhea may be treated with drugs that inhibit prostaglandin synthesis, such as aspirin and NSAIDs. Vitamins and antacids will not relieve symptoms of dysmenorrhea. Morphine use is reserved for acute or severe pain, not generally for chronic conditions like dysmenorrhea.
  26. Many of the symptoms of polycystic ovary syndrome (PCOS) are believed to be due to an excess of which hormone?

    a.

    Antidiuretic hormone (ADH)

    b.

    Growth hormone (GH)

    c.

    Insulin

    d.

    Thyroxine
    ANS:     C

    Many of the symptoms of PCOS are a result of excessive levels of insulin in the blood because of insulin resistance. Excess insulin, in turn, stimulates secretion of androgens. ADH, GH, and thyroxine are not believed to cause the symptoms.
  27. The nurse is caring for a patient who is breastfeeding and receiving antibiotics for mastitis. What should be included in the teaching? (Select all that apply.)

    a.

    Stop breastfeeding, and switch to bottle feeding.

    b.

    Change the infant’s feeding position on the breast frequently.

    c.

    Wash hands before handling the breast.

    d.

    Apply cool packs to the breast to ease pain.

    e.

    Wear a bra to support the swollen painful breast.

    f.

    NSAIDs may be used to help control pain.
    ANS: B, C, E, F

    Patient teaching should include instructions to wash hands carefully to prevent the spread of infection. If the patient is breastfeeding, breastfeeding is often continued to promote drainage of the breast, mother/infant bonding, and infant nutrition. The infant is often already colonized with the bacteria, so further exposure is not thought to be detrimental. Frequent changes in feeding positions can help empty the entire breast. Cool packs will reduce blood flow, which is not desirable. NSAIDs, warm packs, and breast supports are often used to control pain and swelling.
  28. Nurses should teach women that compared with benign breast growths, cancerous growths tend to have which of the following characteristics? (Select all that apply.)

    a.

    They tend to be more painful.

    b.

    They tend to be harder.

    c.

    They tend to be more irregularly shaped.

    d.

    They tend to have more clearly defined borders.

    e.

    They tend to be less mobile.
    ANS: B, C, E

    Cancerous growths tend to be harder, less mobile, less painful, more irregularly shaped, and have less clearly defined borders than benign growths.
  29. Although the use of hormone replacement therapy (HRT) for perimenopausal symptoms is still under investigation, the results of a large-scale study halted in 2002 reported which of the following findings related to HRT? (Select all that apply.)

    a.

    A reduction in total fractures

    b.

    A decrease in strokes

    c.

    A decrease in colorectal cancer

    d.

    An increase in thromboembolism

    e.

    An increase in heart attacks

    f.

    A decrease in breast cancer
    ANS: A, C, D, E

    Research on HRT has shown a 26% increase in breast cancer, a 41% increase in strokes, a 29% increase in heart attacks, doubling of venous thromboembolism rates, and an overall 22% increase in cardiovascular disease. Positive findings with HRT included a one-third reduction in hip fractures, a 24% reduction in total fractures, and a 37% decrease in colorectal cancer.
  30. The nurse is providing care for a patient after a hysterectomy. Which of the following interventions are appropriate to prevent constipation? (Select all that apply.)

    a.

    Increase oral fluid intake.

    b.

    Provide a high-fiber diet.

    c.

    Encourage ambulation.

    d.

    Withhold pain medication.

    e.

    Provide stool softener as ordered.

    f.

    Increase protein intake.
    ANS: A, B, C, E

    Fluids, fiber, and exercise all help relieve constipation. Opioid analgesics are constipating but should be given to control the patient’s pain and prevent additional complications related to pain and immobility. Stool softeners may be ordered if no complication related to the surgery is present. Increased protein intake will not help prevent constipation.
  31. What methods of abortion are most commonly used to terminate a pregnancy of less than 14 weeks? (Select all that apply.)

    a.

    Menstrual extraction

    b.

    Dilation and evacuation (D&E)

    c.

    Vacuum suction

    d.

    Dilation and curettage (D&C)

    e.

    Saline induction
    ANS: A, C, D

    Early in a pregnancy (during approximately the first 13 weeks), there are three primary means of pregnancy termination—menstrual extraction, vacuum aspiration, and D&C. D&E and saline induction may be used later in pregnancy.
  32. The nurse is caring for a woman who has just had an uncomplicated abortion. What instructions should the nurse provide? (Select all that apply.)

    a.

    “Call if you have more bleeding than a heavy period.”

    b.

    “Call if you bleed for more than 3 days.”

    c.

    “You can expect moderate bleeding and a low-grade fever for about a week.”

    d.

    “Don’t be surprised if you pass clots. Call if they are larger than a golf ball.”

    e.

    “The discharge often has a foul odor due to the procedure.”

    f.

    “You should abstain from sexual intercourse as directed by your physician.”
    ANS: A, B, F

    Instruct that bleeding should not exceed that of a heavy period, that the passage of clots larger than a quarter may be a sign of complications, and that the discharge should not become foul smelling. Bleeding more than 3 days or passing large clots should be reported. Fever indicates infection. The patient should be advised to abstain from sexual intercourse for the time specified by the health-care provider (usually about 3 weeks).
  33. Which of the following are risk factors for the development of cervical cancer? (Select all that apply.)

    a.

    Being nulliparous

    b.

    Having multiple sexual partners

    c.

    Smoking

    d.

    Being infected with herpes simplex virus type II

    e.

    Using barrier contraceptives

    f.

    Being infected with human papillomavirus
    ANS: B, C, D, F

    Some identified risk factors for development of cervical cancer include starting sexual activity at an early age, having multiple sexual partners, having several pregnancies, smoking, and being infected with human papillomavirus or herpes simplex virus type II (HSV-II). Use of oral contraceptives (not barrier) for several years may also increase a woman’s risk of developing cervical cancer, although part of the difference in incidence may be because women using oral contraceptives may not be using barrier protection against sexually transmitted diseases (STDs).
  34. The nurse is providing care for a woman with trichomoniasis who is being treated with metronidazole (Flagyl). Which of the following statements by the patient indicates that further teaching is necessary? (Select all that apply.)

    a.

    “I should take this medication until the symptoms are gone.”

    b.

    “This medication should be taken on an empty stomach.”

    c.

    “My partner should see a physician for treatment as well.”

    d.

    “I may have some vaginal dryness while taking this medication.”

    e.

    “I might notice a metallic taste with this medication.”

    f.

    “Drinking alcohol while taking this medication will cause nausea and vomiting.”
    ANS: C, D, E, F

    Use medication as directed, even if symptoms cease. Take with meals. Treat partner. Side effects include dizziness, weakness, insomnia, abdominal cramping, anorexia, nausea/diarrhea/emesis, vaginal dryness, overgrowth of other infectious organisms, and metallic taste. Concurrent use of alcohol and metronidazole will induce severe nausea and vomiting.
  35. The nurse is providing care for a woman suffering from premenstrual syndrome (PMS). Which of the following nursing actions would be included in the plan of care? (Select all that apply.)

    a.

    Encourage the client to stop smoking.

    b.

    Provide food that promotes increased intake of simple sugars.

    c.

    Teach client to limit alcohol consumption.

    d.

    Encourage the client to develop a regular exercise regimen.

    e.

    Instruct client to increase intake of products containing caffeine.

    f.

    Provide small, frequent meals to reduce food cravings.
    ANS: A, C, D

    Lifestyle measures to reduce the effects of PMS include restriction of alcohol, caffeine, nicotine, salt, and simple sugars; participation in regular exercise; and development of stress management skills that may help to reduce symptoms. Small, frequent meals are not necessary.
  36. When determining the amount of blood loss during menses, the nurse should know that a 1-g increase in the weight of the perineal pad represents blood loss of ____________________ mL.
    ANS:      

    1

    A 1-g increase in pad weight equals approximately 1 mL of blood loss.
  37. For the “morning-after pill” to be effective, it should be taken within ____________________ hour(s) of unprotected sexual intercourse.
    ANS:      

    72

    The “morning-after pill,” or emergency contraceptive treatment, consists of postcoital administration of sufficient estrogen or an estrogen/progestin combination to cause sudden sloughing of the endometrial lining of the uterus, preventing implantation of a possibly fertilized ovum. For this to be effective, the initial dose is generally given within 72 hours of intercourse.
  38. Use of RU-486 results in a chemically induced abortion up to the ____________________ week of pregnancy.
    ANS:      

    10th

    RU-486 is a progestin antagonist that prevents the binding of progestins at their receptors, resulting in a chemically induced abortion up to the 10th week of pregnancy.
  39. ANS:    A

    Factors that increase the risk of development of breast cancer include increasing age, personal or family history of breast cancer, high-fat diet, high alcohol intake, treatment with estrogens (especially when used without progestins), early menarche, late menopause, no pregnancy or late first pregnancy, and no breastfeeding or breastfeeding for short periods of time following delivery.
Author
mayjher
ID
344430
Card Set
chapter 42
Description
women reproduction system disorders
Updated